Diehl A M
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Semin Liver Dis. 1999;19(2):221-9. doi: 10.1055/s-2007-1007111.
Nonalcoholic steatohepatitis (NASH) is an hepatic disorder with histologic features of alcohol-induced liver disease that occurs in individuals who do not consume significant alcohol. NASH is believed to be one of the most common explanations for abnormal liver chemistries in American adults. Risk factors for NASH include obesity, type II diabetes, hyperlipidemia, total parenteral nutrition, jejuno-ileal bypass surgery, and the use of certain drugs. However, some patients with NASH have no identifiable risk factors for the disease. Clinically, NASH is a diagnosis of exclusion that should be suspected as a cause of chronic hepatitis in patients who deny significant alcohol consumption and have negative serologic tests for congenital and other acquired causes of liver disease. The identification of fatty liver on imaging studies supports the diagnosis of NASH, which can be established definitively by liver biopsy. The latter also provides useful prognostic information since most patients with simple steatosis follow an indolent clinical course, whereas those with steatohepatitis, fibrosis, or cirrhosis are more likely to develop clinically significant complications of liver disease. Weight reduction and treatment of confounding medical conditions are the mainstays of therapy for NASH. However, there is little evidence that any of the current treatments prevent progression to more histologically advanced stages of NASH. Several experimental therapies, including treatment with bile acids, antibiotics, nutritional supplements, and antioxidants, have had anecdotal success in selected patients, but improved understanding of the pathogenesis and natural history of NASH will be required to develop generally effective therapy for the disorder.
非酒精性脂肪性肝炎（NASH）是一种肝脏疾病，具有酒精性肝病的组织学特征，发生在不大量饮酒的个体中。NASH被认为是美国成年人肝脏化学指标异常最常见的原因之一。NASH的危险因素包括肥胖、II型糖尿病、高脂血症、全胃肠外营养、空肠回肠旁路手术以及某些药物的使用。然而，一些NASH患者没有可识别的疾病危险因素。临床上，NASH是一种排除性诊断，对于否认大量饮酒且先天性和其他后天性肝病血清学检查阴性的慢性肝炎患者应怀疑为此病。影像学检查发现脂肪肝支持NASH的诊断，最终诊断可通过肝活检确定。肝活检还提供有用的预后信息，因为大多数单纯性脂肪变性患者临床病程进展缓慢，而那些患有脂肪性肝炎、纤维化或肝硬化的患者更有可能发生具有临床意义的肝病并发症。减轻体重和治疗并存的内科疾病是NASH治疗的主要方法。然而，几乎没有证据表明目前的任何治疗方法能预防NASH进展到组织学上更严重的阶段。几种实验性治疗方法，包括使用胆汁酸、抗生素、营养补充剂和抗氧化剂治疗，在部分患者中取得了一定成功，但需要对NASH的发病机制和自然史有更深入的了解，才能开发出针对该疾病的普遍有效的治疗方法。
